Overlap of high-functioning autism and BPD--anyone else looked into this?

[Leaf56]

My 24-year-old son has had traits that I've long-suspected of being indicators of high-functioning autism since he was 6 months old (extreme sensitivities, aversion to certain people, fears, perseverative behaviors, narrowly focused interests). He was tested as early as age 5 by a highly respected neurodevelopmental psychiatrist and her team at a hospital-affiliated child development research center and as recently as this past winter by a top NYC specialist who spent 10 hours evaluating him. There were other evaluations done in between at various points. Not one of them ever gave a diagnosis of any sort of autism. The most anyone could ever say was that he exhibits certain traits consistent with high-functioning autism. I'm wondering if others here have children with similar backgrounds where you suspected they might be high-functioning autistic before you ever thought of BPD. There are numerous studies and papers on the overlap that I've read so I know it's a thing, but I'm looking for anecdotal reports here.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[By Still Water]

Hi Leaf56,

I’ve begun to wonder about this, myself.
Our uBPD son has ADHD and OCD. As a child, he had an intolerance to the usual loudness of the school cafeteria - also to loudness of circuses. He’d become unglued and anxious. His gait, down stairs, was quite awkward - two feet on one step, then two feet on another, and so on. Fine motor skills delay...not walking until 22 months...high IQ...obsessed with topics, beyond the normal kid stuff.

[Leaf56]

So is this not something many folks have thought about? Not many people viewed the post so I'm guessing not. His father/my ex-husband is currently running with the idea that our son is autistic, even though every time I suggested our son might be autistic when he was a child my ex said it was nonsense and even though every eval our son has had has determined him to have autistic traits but not to be diagnosable as autistic. My ex is also now convinced that he himself is autistic. He's not. However, I do wonder about the overlap of symptoms and why that is and I wonder how prevalent the overlap of this specific set of symptoms is. Our son could not handle noise, crowds, tactile stickiness, strange foods, heat, but he with therapy and very understanding teachers and parents, he gradually adapted and stopped reacting and learning coping skills and eventually most of his sensitivities subsided. His high reactivity and explosive anger that involved complete meltdowns and endless tantrums also subsided around age 11 and he stopped having those episodes. Literally as I'm typing this I'm realizing that it was at this time that me and my ex got divorced that our son stopped expressing all this anger and that all this angry behavior only started back up again since my son moved in with his dad nearly 2 years ago. In between my son had lots of depression and suicidality but none of this expressed rage. Huh...

[kells76]

Hey Leaf56;

While I haven't researched it myself, there is a 3 page long thread here about your very question:

https://bpdfamily.com/message_board/index.php?topic=21363.0

I hope that helps!

FYI, the pwBPD in my life is my husband's kids' mom, and because she has 0 autistic/Asperger's traits, that's why I haven't pondered the crossover very much.

[Leaf56]

Yes, yes! Thanks so much for posting the old thread. I really should spend some more time reading back through the old stuff here!

[I Am Redeemed]

Hi there.

Just wanted to say I have wondered about my own son, age 5. He is currently in occupational therapy for sensory seeking (not avoidant) behavior. He refuses all but a few select foods, he wears only certain specific clothes, he has targeted interests (trucks and cars and trains). He doesn't really "play" with toys; he mostly lines them up, stacks them, or runs them off the table to crash into the wall. He has regressed in potty training. His OT sees signs of anxiety, and I have him on a waiting list for a therapist.

His father displays traits of BPD, PPD (paranoid personality disorder) and ASPD (anti-social personality disorder). It seems to be prominent on his father's side of the family.

I will be interested to see input in this thread.

[Leaf56]

I just read the other thread (very long but very informative) and am now wondering if I should post on it to revive it or continue here without its benefit. Guidance from mods appreciated

[Ventak]

Trying to find a way to respond to this thread without writing a novel...

Autism is a very complex neurological condition, with about 40 different characteristics.  Nobody has all 40 of these, it's a mixed bag.  This makes it extremely difficult to diagnose.  It is also graded on a scale, and numbers as low as 27 can be either autistic or neuronormative.  Anything over 37 is considered autistic under any condition.  I'm a 38, my BPDw is a 39.  Even then the numbers can be misleading... did my W score high because she is autistic or did she score high due to her extreme social anxiety and depression issues... or does she have those issues primarily because she is autistic?  We will likely never know.

I've personally decided that the only real value in an official diagnosis is if it is needed for special education assistance or as self validation.  Our daughter is at 2.5 diagnosed at level 3 autistic and there is a good chance that she will need government assistance her entire life.  Our son has not yet had his diagnoses but at 2.5 his speech was at an 8 month level.  Both are in Early intervention programs through our local school district.

My W spent years working with autistic children, and noticed many of their characteristics in me.  I had never even considered it for myself, because I don't have most of the socially obvious issues.  However, just about everything about myself that I have learned is odd or not normal.. If I google "weird thing Ventak does, autism" there is a match 95% of the time.  So for me it has been very validating to know that while I'm odd, at least I'm odd in the same way as others.  So now I have a tribe...  My W expressed the other day that it was hard for her not having a diagnosis because there are times she wants to share her autism to help others understand her better.  It is important to understand that you can be both autistic and BPD, which may be the case with her.

Couple of things that are very common among autistic people.  Adrenaline release is broken.  You either get no adrenaline released and remain very calm and collected and logical... or it is all dumped at once and you completely lose control.  This can seem similar to BPD.  The difference I see between myself and my W is that data being correct is exceptionally important to me, and even during an adrenaline dump I am quickly able to see if my analysis of events was incorrect and restabilize myself.  My BPDw on the other hand will make up data that has no basis in reality, refuse to even consider looking at something that might go against her narrative, and will utilize circular arguments and talk over me if I am trying to make a point that will help her understand my logic.  These feel very un-autistic to me, and are not any characteristics I've read about others having...

The other interesting thing is that people often feel that autistic people lack emotion.  That is completely untrue... however, we do feel emotion differently than the neuronormative, and also differently than each other for the most part.  The difference is that the neuronormative population will usually have a range of emotional response that is consistent with others.  So a cat dying would have a level 50-70 on the emotion scale.  Stubbing your toe might be 20-40.  Getting married might be 80-100.. etc...   For autistic, their emotion scale is unique.  For instance, a family member dying is to me about a 20 emotion, but a scene in a movie where a father does something for a child will be an 80.  I will often laugh at scenes in a movie that no others find humorous... and wonder why people are crying at other times.  Other peoples emotional responses seem very very strange to me, and I've had to "learn" what others expect in certain situations to prevent laughing at what others consider very sad or saying something inappropriate to the events at hand.

Another thing to look for, is that almost all autistic people I've dealt with agree that words are both very literal and the meaning is very important.  On the far end of this scale, if you say it is raining cats and dogs, the autistic will need to train themselves to understand you are saying it is raining hard... but they will immediately process it as dogs and cats falling from the sky.  When someone asks me "how are you", it is nigh impossible for my brain to stop evaluating my entire day for success/failure and average emotional state and just say "Excellent!  How are you" (which is what I've trained myself to do).

It is also very difficult for an autistic person to lie, and deception is a lie.  For me, I have to plan it in advance, give myself a believable backstory that makes the lie seem right... and then I can.  But if you ask me something in general conversation that I haven't pre-scripted... it will always be truth, and much more information than you really wanted to hear...

Did any of this resonate with characteristics of your son?  If you can give details of what you observe that gives you question I will be happy to try and see how it fits my experience or research.

[Leaf56]

Oooh, yes, let's play! He's almost 25. At 23 he went to live with his dad nearby, and within a few months he'd dropped out of the second year of his master's program, started smoking a ton of weed, became so depressed he spent entire days/almost weeks in bed, stopped showering, developed an extreme anger toward me (all I'd ever heard otherwise his entire life was how much he loved me), and constant suicidal ideation. He said he'd always felt this way and had just been keeping it in. There was also a bizarre couple of months when he said he thought he was maybe going to become a serial killer and that he'd always liked the idea of killing people and killing women because they deserve it. He asked several times if I could just support him so he wouldn't have to work and to do drugs and have sex as much as possible. Then a few months later he took it all back, said he was just lying to piss me off. But believe me when I tell you he spent a lot of time convincing me that it was all true so I was terrified of him and hospitalized him and tried to find a good therapist etc. then covid hit. He apparently did several acid trips that he said readjusted his brain. He started taking Lexapro, then he went totally psycho and he had to be hospitalized again. Then he didn't speak to me for 5 months, which was awesome because I needed a break. Then it was all back to mommy mommy I love you so much, etc. so for the past 7 months I engaged a world-renowned psychiatrist to care for him but he quit after hospitalizing him and then he checked himself out against medical advice. He says over and over that he never wants to work, that working is for "slaves," that women are all horrible and all he wants to do is have sex with them. Then he switches back into oh mommy mommy mommy I love you so much, save me, etc.

At birth he was different. Extreme startle reflex, fear of most people except ones he selected and then he could play all day with them, became completely fixated on them. He'd have massive meltdowns, was insanely competitive, was prone to flying into rages that could become violent but I was always very on top of all that so I felt that when he stopped doing it around age 11 that he had gotten better. He tells me that in fact it all just went underground and he forced himself to become more normal so he'd be accepted but that what really motivated him was his obsession with having sex. He says that everything about his world became about that and that everything he did was in pursuit of that. But his inability to relate to women and the realization in his mind that all women want is money has led him to have this meltdown of all meltdowns. But besides  all this, he has all the sensitivity traits of someone with ASD, all the "weirdness," all the outcast stuff and in the end I just can't really tell. We'd set up playdates with him with Aspie kids thinking they'd get along but they never did. The aspie kid would just go off to his room and my son would be there entertaining the kid's parents or somesuch. He just never seemed as bad as they did and they were very high functioning. He had several good friends all throughout elementary school and is still friends with them. He makes friends easily but says he feels no connection to them, but then turns around and says they're great. He idolizes me then despises me (although truth be told he's spent 24  years idolizing me and less than a year despising me). I thought for a while he was in the prodrome of schizophrenia, but he still hasn't had any psychotic episodes. The top psychiatrist, before he quit, diagnosed him with psychotic depression, but that just doesn't seem right either, and he's no different off the antipsychotic than he was on it. He says he's just been lying about being suicidal all these years, then he turns around and says that's wrong too. The top NYC psychiatrist said he's the most complicated case of the 35,000 patients he's been involved in the treatment of over his career and that he's completely unique. Yep, that's my kid!

[Ventak]

I'm so sorry you have spent all these years with this pain.. I can't even imagine.

The first paragraph sounds very much like my wife, who has been diagnosed co-morbid BPD and Anti-Social PD.  She has not yet been diagnosed for Autism, but I give it 50/50 that she is.  She also has PTSD from childhood and the loss of five children in the 2nd trimester.  Some psychological profiles do not fit neatly into a single category, and I grieve for the pain she is in.  Living through these things must be exceptionally difficult for them.

Some of the 2nd paragraph resonates with me, and some I see in my BPDw.  The big difference with relationships I've found is around communication.  Autistic people communicate more effectively with other autistics.  Studies have shown that a group of autistics communicate as well as a group of neuronormatives, it is when they get mixed that communication takes more work.  Some medication helps my wife, some makes her worse.  One medicine turned her violence up a couple notches and literally led to psychotic events.

I'm not a psychiatrist, but it sounds to me like your son has multiple mental health issues, and may also be high functioning autistic without some of the social characteristics.  That describes my autism as well, so I know you can seem socially close to normal.

I do know that expression of negative emotions is directly related to stress.  Was there new stress that occurred a couple years ago?

[Leaf56]

Well, from a borderline's perspective, he was about to graduate from graduate school and would have then been forced to face the fact that school and all it's requisite coddling was about to come to an end and he would have to :gasp: get a job. I think that caused some stress, but by the same token, by not finishing now he says the only thing that causes him stress is not being able to get a job that makes a lot of money.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Ventak]

Interesting... my BPDw was half a class away from graduation and never quite got there.  While the trauma of a late 2nd trimester pregnancy loss explains a delay... she's not been able to motivate herself to finish in 8 years.

Those issues feel more BPD than autistic to me.  But I really suspect that your son is dealing with comorbidity issues with too many factors to isolate.

[losttrust]

Lots of similarities so I truly doubt - your son so unique as the psych group would lead you to believe.  But lots of money being made while us  parents and kids are lead down paths dispirited to help get our kiddos “fixed”.  Too many on this site to be considered “one off” situations.  

Is this Some sort of autism? ADD? Emotional dysregulation at early ages seem a common component of many.  Add to it stress of competition for attention, inability to identify fact from fiction, impacts from the constant use of the Iphone, Twitter Snapchat. Idealization of others, sever immaturity, low self esteem - all these factors mixed together seems to have overwhelmed their brains- too many signals.  Then they self medicate which kills more brain cells  Don’t know.  We all have been bullied somehow. Wronged by someone at one time..  Why do some rebound while others spiral downward and inward - unable to self sooth.  Is it Darwinism? What I will warn you all of. Some meds prescribed make these kids impotent which adds a new layer of self loathing.  The docs are well aware of potential side effects but prescribe without mentioning. Once done it’s done and purple pill for a 20 year old is tough.   While I’m actually secretly glad he can’t in-pregnant another easily as selfish I’d rather not see this dna continue onward. - I think it’s PLEASE READty he wasn’t given fair warning.  Those of you with teens. Act swiftly and demand information for treatment. Don’t be trusting.  Always demand stats and logic.  Meds don’t always work. Sometimes they harm.

[sheepdreaming]

I am new to this board today and found it because I was looking online for an answer to the same question. I have a 17 year old trans son who has been exhibiting BPD for 4 years and just got diagnosed with autism last year. We have all gone through DBT skills group by people personally trained with Marsha Linehan and my son still has weekly DBT personal therapy. I figured out he might be autistic one day when I found a link between autism and transgenderism. The parent coaching we got only made our relationship worse, with our son telling us we have been gaslighting, abusing and traumatizing him for the last 4 years. I tried to validate whatever we unwittingly did to him, not knowing he was autistic. (We are imperfect but loving parents who ARE NOT abusive at all and with a good relationship with his neurotypical brother, btw). My son gets angry and says we are gaslighting him if we disagree with anything he says or does. We always try to deescalate situations by listening and validating the valid, but it has recently gotten worse with him overstepping my boundaries and getting physically aggressive. I am hoping to find a DBT therapist now who specializes in Autism since autistics don't always respond to behavior consequences put in place. He is going to college next year but living at home, so I am really panicked at the thought he will be here for another 4 years without any further treatment.

[Ventak]

Welcome sheepdreaming, so glad you found us!

It sounds like you are taking really good steps with your family to improve everyone's lives.  It is also important to take care of yourself...  what steps are you taking to meet your own needs?  Do you have a good support system in place?

I understand your fear about living in that environment.  Do you believe you are in physical danger if he stays?  What are your biggest concerns?

[sheepdreaming]

Thanks, Vantek. I am in therapy as well and I have a wonderful network of family and friends who support me. I don't feel unsafe all the time- just when he gets out of control. I have my husband to protect me in those times in case anything were to happen to me. My concern is for my child's well being and future.

[Elizabeth22]

He was tested as early as age 5 by a highly respected neurodevelopmental psychiatrist and her team at a hospital-affiliated child development research center and as recently as this past winter by a top NYC specialist who spent 10 hours evaluating him. There were other evaluations done in between at various points. Not one of them ever gave a diagnosis of any sort of autism.

I am curious why you think he is autistic when extensive testing by highly qualified individuals says otherwise
We just had an autism diagnosis in our family, well the most recent there are others

[RockyMountainBon]

Hi. I just wanted to say I recognize so much of a lot of what Sheepdreaming and Leaf wrote about. My son, (19) diagnosed with Asperger's when he was around 11. Smart, smart, smart kid. It runs in his dad's family. Dad has it, Grampa has it, also his dad's daughter from another marriage has it. I hate to say "has it", it's not like a disease. My son is incredibly smart. He taught himself 5 languages. He can play almost any musical instrument. He's a budding DJ in the Denver area. Well, this is all very nice, but he has for about six years now: been depressed, has rages, the police have visited my home countless times, he's been brought to the ER for suicide ideation a handful of times. Last Labor Day weekend, he ended up in a 72 hour hold. He never really had any friends for any period of time. He can only work at a job for about 2 months, then hates it. Hates his supervisors, managers. I have suspected BPD for a while. On the other hand, I am pretty sure I also had BPD and I worked with DBT and can recognize some of the ways of thinking and am learning how to deal with him better, although still feel like I'm walking on eggshells (yes, I read that book too). His behavior has pushed his sisters away (they are all adults living in different states). My husband (his dad) and I have gone through so much to try to help him. He was seeing a therapist, but stopped. We are applying for another one. He just quit his job a few nights ago, the cops had to come to calm him down (he smashed his head into the refrigerator). He is going to go through a bankruptcy because he had no control over his spending. It's been hell and yet I worry about him all the time. He is not functional to be on his own. So while he is not working, I want him to get intense therapy where he meets several times a week. He won't go to a term facility because of the negative experience on the 72 hour hold (they basically let him just sleep the entire time he was there, and there was no follow up). Anyway, mostly I'm venting, but I do know Asperger's (or now they call it Autism) and I'm pretty sure I know a thing or two about BPD. If anyone ever wants to write me if they ever need to vent about this very combination, I'm here!

[Rev]

Lot's great stuff here - so I won't add, except to say:

There's a difference between traits and a root cause that produces a diagnosis.

Regardless of the cause, how we respond to the traits are in our hands. Regarding the root causes, that's in the hands of the person to manage their condition.

Nice post.

Rev.

PS - Pretty sure my now ex was on a spectrum of some kind. She had an evaluation of some kind in her past that she never really wanted to talk about - but it was tied to agressive / abusive behavior. She was prevented from meeting with school staff without the presence of her children's father.  Factoring in this, her behavior was not purely BPD.  Not really important to share, I guess, but thanks for listening.

[Elizabeth22]

Yes about traits.
For instance, BPD and PTSD share some traits, and you can have PTSD without having BPD.